| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
463 |
449 |
$16K |
| V2020 |
Frames, purchases |
556 |
545 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
158 |
158 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
274 |
271 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
106 |
106 |
$845.00 |
| 92015 |
Determination of refractive state |
891 |
871 |
$31.24 |